Nokea
A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patient's care plan?
- A. Protective isolation and vigilant use of standard precautions
- B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene
- C. Including the family in planning the patient's activities of daily living
- D. Monitoring and treating the patient's pain
Correct Answer: A
Rationale: The correct answer is A: Protective isolation and vigilant use of standard precautions. This is the priority because patients with AML undergoing induction therapy are immunocompromised and at high risk for infection. Isolating the patient and using standard precautions help prevent exposure to pathogens.
B: Providing a high-calorie, low-texture diet and oral hygiene is important but not the priority as infection control takes precedence.
C: Including the family in planning activities of daily living is beneficial for holistic care but not the priority compared to infection prevention.
D: Monitoring and treating pain is essential, but in this case, infection prevention is the priority due to the patient's immunocompromised state.
You may also like to solve these questions
A 12-year-old patient with localized osteosarcoma is being treated with cisplatin, doxorubicin, and high-dose methotrexate. The pain at his primary site rapidly resolves after initiation of chemotherapy. After tumor resection, pathology reveals the tumor was greater than 95% necrotic. You want to continue cisplatin, doxorubicin, and high-dose methotrexate. Which of the following is the best answer regarding the evaluations that should be performed to monitor for toxicity in patients receiving cisplatin, doxorubicin, and high-dose methotrexate?
- A. Complete blood count, creatinine, liver function tests
- B. Complete blood count, serum electrolytes (sodium, potassium, BUN, chloride), and EKG to monitor for prolonged QTc
- C. Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram
- D. Complete blood count, creatinine, serum magnesium, chest x-ray
Correct Answer: C
Rationale: The correct answer is C: Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram. This choice includes essential monitoring tests for potential toxicities associated with cisplatin, doxorubicin, and high-dose methotrexate. Here's the rationale:
1. Complete blood count: To monitor for hematologic toxicities such as anemia, neutropenia, and thrombocytopenia.
2. Creatinine: To assess renal function, as cisplatin can cause nephrotoxicity.
3. Serum magnesium: Methotrexate can cause hypomagnesemia, necessitating monitoring.
4. Audiogram: Doxorubicin can lead to hearing loss, thus an audiogram is needed for early detection.
5. Echocardiogram: Doxorubicin can cause cardiotoxicity, so an echocardiogram helps in monitoring cardiac function.
Each of the other choices lacks one or more essential monitoring tests
The nurse notes that a patient's gaping wound is developing a blood clot. Which body substance is responsible for this clot formation?
- A. Plasma
- B. Platelets
- C. Red blood cells
- D. White blood cells
Correct Answer: B
Rationale: Platelets are responsible for clot formation in the body. When a wound occurs, platelets are activated and adhere to the site, forming a plug to stop bleeding. They release chemicals to further enhance clot formation. Plasma is the liquid component of blood, red blood cells carry oxygen, and white blood cells are part of the immune system, none of which are directly involved in clot formation.
A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patient's needs for physical activity?
- A. Teach the patient about the risks of immobility and the benefits of exercise.
- B. Assist the patient to a chair during awake times, as tolerated.
- C. Collaborate with the physical therapist to arrange for stair exercises.
- D. Teach the patient to perform deep breathing and coughing exercises.
Correct Answer: B
Rationale: The correct answer is B because assisting the patient to a chair during awake times allows for gradual physical activity, promoting mobility without overwhelming the patient. This option supports the patient's need for movement while considering their current level of fatigue.
A is incorrect because educating the patient about the benefits of exercise may not be feasible or appropriate given the patient's current fatigue levels.
C is incorrect as stair exercises may be too strenuous for a patient experiencing debilitating fatigue, potentially leading to further exhaustion and risk of injury.
D is incorrect because deep breathing and coughing exercises primarily focus on respiratory health and may not directly address the patient's need for physical activity to combat fatigue.
A 16-year-old patient with a left-side pelvic osteosarcoma is taking extended release oxycodone twice daily as well as immediate release oxycodone for breakthrough pain approximately 2 or 3 times per day. She describes her pain as burning, tingling, and shooting in her left leg. Her pain worsens with hot showers. Her most recent EKG has a QTc of 495. What would be the best strategy to manage her pain?
- A. Switch from long-acting oxycodone to methadone.
- B. Recommend more frequent use of her immediate release oxycodone.
- C. Add amitriptyline daily. Start low and titrate upward on dosage.
- D. Add gabapentin three times daily. Start low and titrate upward on dose.
Correct Answer: D
Rationale: Step 1: The patient's pain is described as burning, tingling, and shooting in her left leg, which suggests neuropathic pain.
Step 2: The pain worsens with hot showers, indicating sensitivity to temperature changes, a common feature of neuropathic pain.
Step 3: Gabapentin is a first-line medication for neuropathic pain, as it stabilizes nerve cells and reduces abnormal pain signaling.
Step 4: Starting low and titrating upward on gabapentin dose helps minimize side effects and optimize pain relief.
Step 5: Methadone (Choice A) is not the best option for neuropathic pain. Increasing immediate release oxycodone (Choice B) may lead to opioid tolerance. Amitriptyline (Choice C) may help neuropathic pain but is not as specific as gabapentin.
An 18-month-old boy, whose parents are first cousins, is referred to you because of a significant episode of epistaxis. The parents report that the child had bleeding after circumcision and large hematomas with immunizations. Platelet aggregation studies show the following: This child's platelets are unable to interact with which of the following?
- A. ADP
- B. Fibrinogen
- C. von Willebrand factor
- D. Platelet factor 4
Correct Answer: B
Rationale: The correct answer is B: Fibrinogen. In this case, the child is likely suffering from Glanzmann thrombasthenia, a rare inherited platelet disorder where platelets lack the ability to bind to fibrinogen. This results in impaired platelet aggregation and clot formation, leading to bleeding tendencies. The other options (A, C, D) are not affected in Glanzmann thrombasthenia. Platelets interact normally with ADP (A), von Willebrand factor (C), and Platelet factor 4 (D) in this disorder.